Newark Hospital

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Feedback from people and staff was positive about the quality of end of life care provided by the trust.
There was a clear vision and strategy to ensure the delivery of high quality care and treatment.
There was a shared direction and culture throughout the end of life care service. Leaders supported
staff and collaborated with health care partners to deliver care that was safe, integrated, personcentred and sustainable, and to reduce inequalities.
Patients and their loved one’s views were sought and valued

We have not awarded this service a score for Well-led.

Find out about when we will not publish a key question score and what we look at when we assess Well-led.

The focus for all staff and leaders was on the needs of patients receiving care, their families, loved ones
and care givers.

Staff told us, that in end of life care at Newark hospital, there was a very open culture where everyone
could raise concerns without fear and a genuineness among staff that having to raise concerns about
others was an exceptionally rare occurrence.

Staff described the culture they worked in as like being part of a family.

Staff told us that they felt respected, supported and valued. We spoke with leaders who aimed to
promote a team ethos of caring for patients with dignity and respect no matter what their role within
the service. We observed positive interactions between all members of staff regardless of seniority.

Staff were proud of the service and wanted to deliver the best possible care where people were
supported to manage their life limiting conditions and spend their final days peacefully.

Staff described the culture they worked in as warm, open, and like being part of a family. Staff
continually demonstrated a clear understanding of the vision and values and what they wanted to
achieve. Staff were proud of the service and wanted to deliver the best possible care where.
One staff member told us, “It is a privilege to do my job”.

There was a clear sense of teamwork across Sconce ward, and everyone spoke very highly of their
colleagues. When talking with all staff it was clear that their priority was focussing on the needs of the
patients they cared for.

Leaders had the skills and abilities to run the service. They understood and managed the priorities and
issues the service faced. They were visible and approachable in and around the patients and staff. They
supported staff to develop their skills and take on more senior roles.

Staff told us they were encouraged to speak up and discuss their concerns openly. When staff had
raised concerns, they felt the management team could take appropriate action. Staff felt confident
they could raise concerns or risks openly.

Leaders engaged with staff and used staff survey results to explore issues and discuss solutions and
improvements to the service.

The trust had an embedded recruitment process that ensured leaders met the Fit and Proper Persons
(FPPR) guidelines.

Managers and staff understood the importance of staff being able to raise concerns without fear of
retribution. The trust had policies on speaking up, raising concerns and whistleblowing.

The trust had had 1 freedom to speak up guardian (FTSUG) and 9 Freedom to Speak Up Champions
across all the hospital sites.

Staff were aware of the freedom to speak up guardian role and details of what freedom to speak up
was, and who to contact.

Staff who we spoke to told us the culture within the service supported them to speak up and report
any issues or concerns to their managers. Staff told us they felt confident to escalate matters if they felt
their concerns were not being responded to.

The service valued diversity in their workforce. Staff work towards an inclusive and fair culture by
improving equality and equity for people who work for them.

Training was available for all staff in equality, human rights and workplace diversity. This was a
mandatory requirement.

Staff and leaders told us, and we saw that there was a diverse workforce with a positive sense of
inclusion. The service made workplace adjustments where necessary. For example, the ward manager
told us of a number of different workplace adjustments that had been made for various members of
staff including an adjustment in working hours, ergonomic software and disability leave.

The service carried out activities to improve workforce equality, diversity and inclusion. Newark
hospital had a multi-faith room on site, for everyone in the hospital to use, for those of all religions and
none.

Leaders operated effective governance processes, throughout the service and with partner
organisations. Staff at all levels were always clear about their roles and accountabilities.

The trust had effective systems to assess, monitor and mitigate the risks relating to the health, safety
and welfare of service users and others who may be at risk. They had a clearly defined purpose, and
staff were trained to deliver care in line with this purpose.

The end of life care team was part of the clinical support, therapies and outpatients’ division, in the
department for end of life, spiritual and support services.

The EOLC and SPCT had their own governance meetings on a monthly basis. The agendas were
standardised, so teams discussed the same issues. During governance meetings attendees discussed
actions from previous minutes, incidents, safety and governance reports and training. The meetings
were open to every staff member within the team.

The end of life care champions had bi-monthly meetings with a rolling agenda item to discuss
complaints and concerns. The learning from these was then disseminated by the end of life care
champions to the ward staff.

Leaders and staff were clear about where they were in regard to the governance structure and were
clear about who they were accountable to. Staff told us they were free to attend all governance
meetings if they wanted to.

Daily handover huddles were held on the wards every day after nursing handover to update staff of any
relevant issues not discussed at handover.

There was no local risk register specifically for Newark hospital for end of life care. The end of life care
risk register was for both the Kingsmill and Newark site.

We reviewed the risk register which had 2 documented risks. Neither was for Newark end of life care
services.

The trust worked with local health care partners to ensure there was a good understanding of local
needs and improve the care they provided. These included commissioners and stakeholders as well as other providers of care and support across Nottinghamshire.

The EOLC team provided strategic direction and visible professional leadership within the organisation
with regards to end of life care services. The team worked collaboratively with the divisional teams,
hospital clinical teams, the SPCT and all stakeholders within primary and community care services,
clinical commissioning groups and the voluntary sector. The aim was to promote joined up services
that effectively provided coordinated discharge as well as an equitable and high-quality standard of
care.

The chaplain was part of the multi-disciplinary team who worked in end of life care and supported
patients, families and staff as required.

The EOLC team followed the Nottingham and Nottinghamshire Integrated care system end of life care
clinical and community services strategy. This aims to integrate health and social care for holistic
support, focusing on proactive, person centred care closer to home, emphasising early recognition,
sensitive communication, shared decision-making, and support for patients and families.

All staff were committed to continually learning and improving services. Staff described a culture of learning and of opportunities to develop their knowledge and skills. Staff were encouraged to attend multidisciplinary team meetings to develop their knowledge and understanding about end of life care, including to gain an understanding of different treatment options.

A recently completed trust wide ‘Death within 48 hours of admission’ audit had outlined a number of recommendations for improving advanced care planning and personalisation of care at the end of life. The service stated they would be working with the Integrated Care Service towards the recommendations in the near future. At the time of our inspection, the service were planning an annual ReSPECT Development group to undertake a small sample trust wide ReSPECT audit, with the focus on the quality of ReSPECT plans including mental capacity assessments for patients being discharged from the trust. This was to evaluate the results of audits, to direct further quality improvement action and would be in cross reference to the death within 48 hours of admission audit.